Full Name *
Email *
Phone *
Alternate Phone
Street Address *
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
What age of dog are you looking to adopt *	Puppy (8 weeks - 6 months) Adolescent (6 months - 2 years) Adult (2 - 8 years) Senior (8+ years)
What gender are you looking to adopt? *	Male Female No preference
Would you consider a mix? *	Yes No
How many adults live in your home? *
How many children live in your home? *
What are their ages?
Do you currently have pets? *	Yes No
If you answered yes above, please list the types of animals that you have?
Are your pets all current on their vaccinations?	Yes No
Are your pets altered (spayed/neutered)?	Yes No
Do you own your own home?  *	Yes No
If you do not own your home, do you have permission to have a dog?	Yes No
In what type of residence do you live? *	Single family home Mobile home Apartment/Condo
How long will your new dog be left alone during a typical day? *	0 hours 1-3 hours 3-6 hours 6-9 hours 9+ hours
Where will your dog be kept while you are away? *	Inside Only - free run of house Outside Only - no access to house Inside/Outside with dog door Crate Outside Kennel or Run Outside Cable or Chain Laudry Room or other Small Room Garage Access Only
Are you willing to have a New Hope cattle dog representative/volunteer visit your home before adoption? *	Yes No
Are you willing to take your new dog to obedience classes? *	Yes No
Have you ever owned a cattle dog or cattle dog mix? *	Yes No
If you have, where are they now?
Why do you want a cattle dog instead of another breed? *
Who is your current veterinarian (include name of clinic)?? *
How would rate your family's activity level? *	Never active Active 1-2 times per week Active 3-5 times per week Active daily Active only on weekends
How will you transport your new dog in your vehicle (check all that apply)? *	I don't plan to transport Open bed of a truck Free in the backseat Crated in the vehicle Tethered/Tied/Chained in open bed of truck Free in enclosed bed of truck Seat belted in vehicle
Under what circumstances would you consider surrendering your dog?
What would you do if your new dogs bites someone? *
Have you are are you involved in breeding dogs? *	Yes No
List the specific names of dog(s) from our website that you are interested in meeting?
Name *
Email Address *
Phone Number
Name *
Email Address
Phone Number *
Name *
Email Address *
Phone Number *

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